@layout("/common/_form.html",{js:["/assets/couponReceive/couponReceive_edit.js"]}){

<form class="layui-form" id="couponReceiveForm" lay-filter="couponReceiveForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>

                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户id<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="userId" name="userId" placeholder="请输入用户id" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">优惠券id<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="couponId" name="couponId" placeholder="请输入优惠券id" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">二维码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="qrCode" name="qrCode" placeholder="请输入二维码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">二维码标识<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="qrTag" name="qrTag" placeholder="请输入二维码标识" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">券码<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="couponCode" name="couponCode" placeholder="请输入券码" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">0 未核销     3 已核销    1 未开始   2 已失效<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="status" name="status" placeholder="请输入0 未核销     3 已核销    1 未开始   2 已失效" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label"><span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="isDelete" name="isDelete" placeholder="请输入" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户电话<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="phone" name="phone" placeholder="请输入用户电话" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户地址<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="addr" name="addr" placeholder="请输入用户地址" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">用户姓名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="name" name="name" placeholder="请输入用户姓名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" id="cancel">&emsp;取消&emsp;</button>
    </div>

</form>

@}